PROJECT SUMMARY Prescription (Rx) opioid misuse in the U.S. has resulted in a national epidemic of overdose deaths and addiction. An emerging and understudied aspect of the prescription opioid epidemic is the misuse of prescription anticonvulsants, including gabapentin and pregabalin, referred to as gabapentenoids or GABA- analogue drugs (GABA). Early data suggest that GABA misusers are more likely to also misuse Rx opioids, and recent studies found GABA drugs being consumed to potentiate the effect of prescription opioids. The reported effects of GABA misuse include a feeling of euphoria reminiscent of Rx opioids in addition to, sedation, delirium, and disassociation. Population estimates of GABA misuse in the U.S. are not apparent, yet studies indicated that 15%-26% of prescription opioid misusers and as many as 65% of those with a GABA prescription, report GABA drug misuse. Consequences include seizures requiring admission to intensive care units, dependence, withdrawal symptoms, addiction, overdose, toxicity, and death. Despite this growing concern, no apparent systematic data have been published that explicitly examine GABA drug misuse. Given the epidemic of Rx opioid misuse in the U.S. and the growing literature on GABA misuse, the proposed study will utilize a social ecology theory-driven design to describe GABA misuse, and examine risk and resilience factors that influence initiation, escalation, and consequences, from the vantage points of substance users and prescribers. The study site is South Florida, which has significant populations of racially/ethnically diverse Rx drug misusers. The following specific aims will be accomplished: 1) Examine the decision and motivations to initiate GABA misuse and the interplay with Rx opioid misuse; 2) Assess: a) demographic, sociocultural, and psychosocial characteristics across three social ecological domains (intrapersonal, interpersonal, and community) that are hypothesized to influence GABA misuse; and b), routes of GABA administration, modes of acquisition, and consequences of misuse; 3) Investigate aspects of the social ecology of GABA misuse not easily informed by substance users from key informants (i.e., drug diversion investigators; substance abuse treatment professionals; prescribers). The study will advance Goal 1 of NIDA?s strategic plan by identifying environmental, behavioral, and social causes and consequences of GABA drug misuse and will contribute to public health knowledge of an understudied aspect of Rx opioid misuse. The in-depth examination of the social environment, and the identification of risk and resilience factors influencing initiation and misuse, will aid the development of prevention and intervention strategies, including individual and community approaches, as well as inform public policy initiatives, such as prescriber education.